The Skeptics' Guide to EM

FEBRUARY 25, 2023

Reference: Cashen K, Reeder RW, Ahmed T, et al. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Reference: Cashen K, Reeder RW, Ahmed T, et al. Pediatric Crit Care Med. Pediatric Crit Care Med.

CPR 130

CPR ICU Critical Care Defibrillator 130

Core EM

JANUARY 25, 2024

link] [3] Morrison RS, Magaziner J, Gilbert M, et al. Published February 4, 2022. Accessed September 29, 2022, [link] [6] Pepe J, Ausman C, Madhani NB. 2022, Accessed September 29, 2022, [link] [8] Luftig J, Dreyfuss A, Mantuani D, Howell K, White A, Nagdev A. J Emerg Trauma Shock. 2012;5(1):28-32.

Epinephrine 246

Epinephrine ED OR Emergency Department 246

The Skeptics' Guide to EM

MARCH 5, 2022

Date: February 24th, 2022 Reference: Parish et al. Date: February 24th, 2022 Reference: Parish et al. Tricoci et al. The definitions used for each level of evidence are as follows: An update was published by Fanaroff et al in JAMA 2019. We have covered some of these over the 10 years.

Epinephrine 100

Epinephrine ALS OR 100

REBEL EM

JUNE 12, 2024

According to the 2022 Annual Report of the National Poison Data System from America’s Poison Center, CCBs and BBs account for the sixth and seventh largest number of fatalities from overdose. References Gummin DD, Mowry JB, Beuhler MC, et al. Insulin versus vasopressin and epinephrine to treat beta-blocker toxicity. Circulation.

Epinephrine 104

Epinephrine Overdose OR ALS 104

EMDocs

JANUARY 16, 2024

The patient received 1 mg of epinephrine IV x2 with conversion of his rhythm to ventricular fibrillation (VF) for which he was defibrillated twice in the field. He requires low-dose epinephrine to maintain his mean arterial pressure (MAP) in the 60s mmHg and is transported to the cardiothoracic (CT) ICU. Carsten L, et al.

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

REBEL EM

SEPTEMBER 1, 2022

Paper: Vallentin MF et al. Resus 2022. References: Vallentin MF et al. Resus 2022. Additionally, there were non-statistically significant trends toward lower survival and lower survival with good neurologic outcomes in patients receiving calcium at 30 to 90 days. Placebo: 9.1% RR 0.51; 95% CI 0.24 Placebo: 8.6%

Epinephrine 52

Epinephrine Overdose ALS OR 52

EMDocs

APRIL 10, 2024

1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] If epinephrine is used, small initial doses ( <1 ug/kg) are preferred. McGraw Hill; 2022. doi:10.1136/bcr-2019-233119 Neal JM, Barrington MJ, Fettiplace MR, et al. Vasopressin is not recommended.

E-9-1-1 93

E-9-1-1 Plasma Epinephrine EMS 93

REBEL EM

SEPTEMBER 19, 2022

Some look promising (ie eCPR and application of US) while others have been considerably less effective or inconsistent (ie epinephrine and targeted temperature management). Article: Moore JC et al. Resuscitation 2022; 179: 9-17. References: Moore JC et al. Resuscitation 2022; 179: 9-17.

CPR 52

CPR Defibrillator EMS Epinephrine 52

Dr. Smith's ECG Blog

JULY 21, 2024

Epinephrine infusion was begun. In such cases — radiofrequency ablation of ectopic beats triggering malignant ventricular arrhythmias was needed for control of arrhythmic storm because the antiarrhythmic medications tried were ineffective ( Marrouche et al — JACC 5;43(9): 1715-20, 2004 ).

Defibrillator 117

Defibrillator Coronary ALS STEMI 117

REBEL EM

JUNE 8, 2023

1-4 The PDPs, phenylephrine and epinephrine, result in vasoconstriction and increased cardiac contractility. They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine. Paper: Singer S, et al. 2022 Sep 5.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

ACEP Now

JULY 7, 2023

2 Standard management for VT and VF involves the use of electrical defibrillation, high-quality chest compressions, and epinephrine. 5 More recent literature defines “refractory” as VT or VF that is persistent or recurrent despite three shocks from a defibrillator, three rounds of epinephrine, and use of an antiarrhythmic (i.e.,

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

NAEMSP

APRIL 19, 2023

After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. Current AHA guidelines do not recommend routine use of calcium in cardiac arrest (Panchal, et al., Calcium acts as a vasopressor and inotropic agent (Lindqwister, et al., He is found to be in ventricular fibrillation (VF).

E-9-1-1 52

E-9-1-1 Advanced Life Support Overdose CPR 52

Broome Docs

APRIL 6, 2023

Casey The CLOVERS trial: National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, Brower RG, et al. 2022 Dec 16:emermed-2021-211946. Epub 2022 Nov 21. 2022 Jul 2;400(10345):39-47. 2022 Oct;51(10):595-604. 2022 Dec 20;328(23):2296.

Epinephrine 52

Epinephrine ED Emergency Department ALS 52

REBEL EM

MAY 29, 2023

Paper: Ibarra-Estrada, M et al. References: Ibarra-Estrada, M et al. PMID: 36915146 [ Access on Read by QxMD ] Kirov MY et al. PMID: 11588440 Memis D et al. PMID: 12500513 Lopez A et al. PMID: 14707556 Richards-Belle et al. Crit Care 2023. NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9%

ICU 145

ICU ALS Epinephrine OR 145

EMDocs

JANUARY 4, 2024

Other Norepinephrine or epinephrine are preferred vasopressors when needed. Accessed 12/18/2022. In: Brent J, et al. Accessed 12/18/2022. Starr P, Klein-Schwartz W, et al. 2022; 55:232.e3-232.e4 e4 Livshits Z, Feng Q, Chowdhury F, et al. Gosselin S, Hoegberg L, Hoffmann R, et al. Eds (2017).

Overdose 66

Overdose E-9-1-1 ALS Emergency Department 66

REBEL EM

NOVEMBER 6, 2023

Paper: Hiruy A, et al. to 1mg/kg/hr) Information regarding the vasopressors used in the study is as follows: Norepinephrine equivalents = norepinephrine mcg/kg/min + (phenylephrine mcg/kg/min/10) + epinephrine mcg/kg/min + (vasopressin units/min x2.5) REFERENCES: Hiruy A, et al. PMID: 37586951 Mehaffey JH, et al.

Epinephrine 70

Epinephrine ICU ALS OR 70

REBEL EM

DECEMBER 19, 2022

REBEL Cast Ep113 – Defibrillation Strategies for Refractory Ventricular Fibrillation Click here for Direct Download of the Podcast Paper: Cheskes S, et al. REFERENCES: Cheskes S, et al. 2022 Nov 6 PMID: 36342151 Cheskes S, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med.

Defibrillator 52

Defibrillator Paramedic CPR EMS 52

EMDocs

JANUARY 20, 2024

Rosh Review Website Link Further Reading Further FOAMed: [link] [link] References: Ahmad SA, Brito D, Khalid N, et al. doi:[link] Kosuge M, Ebina T, Hibi K, et al. 2006.105.2.264 Templin C, Ghadri JR, Diekmann J, et al. doi:10.1056/NEJMoa1406761 Frohlich GM, Schoch B, Schmid F, et al. 2022 May 17;145(20):e1053].

E-9-1-1 74

E-9-1-1 EMS Coronary ACS 74

EMDocs

DECEMBER 18, 2023

Multiple studies published in 2022 have indicated that, despite disagreement surrounding prognostic accuracy, no such screening tool so far exists. 34 If a MAP of 65 mmHg is still not achieved, epinephrine should be added as a third agent (Figure 1). References Evans L, Rhodes A, Alhazzani W, et al. units/minute. 2021;57(9):920.

E-9-1-1 65

E-9-1-1 ALS Emergency Department Plasma 65

Don't Forget the Bubbles

DECEMBER 5, 2023

Nizami T, Beaudoin F, Suner S, et al. doi.org/10.1136/emermed-2022-212667 What’s it all about? Epinephrine was initially given to both groups after 5 minutes of chest compressions, this delay was based on a previous simulation study looking at length of time to site an UVC. Crocker, B.C.S.,

Coronary 111

Coronary Epinephrine CPR Emergency Department 111